Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 65480 | TX |
N | 101YP2500X | Professional Counselor | 0701007809 | VA |
Y | 101YP2500X | Professional Counselor | 65480 | TX |
N | 101YS0200X | School Counselor | 1245389 | TX |
NPI | 1194060434 |
---|---|
Provider Name | Dr. Angela K Waggoner |
First Address | Pearland, TX 77588-2476 |
Second Address | Pearland, TX 77581-7574 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2012 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0701007809 | LICENSED PROFESSIONAL COUNSELOR - SUPERVISOR (01) | VA |
65480 | LICENSED PROFESSIONAL COUNSELOR - SUPERVISOR (01) | TX |
8267 | LICENSED PROFESSIONAL COUNSELOR - SUPERVISOR (01) | LA |